INSURANCE CLAIM PROCESS

INSURANCE CLAIM PROCESS

Cashless Procedure:
Reimbursement Procedure:

Documents Requirement mandatory for processing of a Claim

Accidental Death Claim

  • Certified True Copy of the F.I.R lodged by Police Authorities
  • Post Mortem Report in Original or certified true copy
  • Certified True Copy of Death Certificate issued by the Municipal Authorities
  • Local Newspaper clipping if the accident has been reported or Eye Witness’s version of the accident (this is not mandatory but it’s presence reduces the TAT of the Investigating Agency)
  • Claim form duly filled in, certified

Temporary Total Disablement

  • Original Certificate from the treating doctor certifying the circumstances & extent of the injury & period of bed rest advised
  • Original Fitness Certificate from the same doctor mentioning that the claimant is fit to resume duty
  • Original Certificate from the Employer acknowledging the leave of absence

Documents Requirement mandatory for processing of a Claim (Re-imbursement)

MAIN HOSPITALIZATION

  • Signed Claim mentioning TPA I.D. No.
  • Original Discharge Summary must have Date of Admission and Date of Discharge, presenting complaints & their duration, final diagnosis, line of treatment given & advice on discharge.
  • Time of admission & discharge should be mentioned in Discharge Summary
  • Original final hospital bill in a proper bill format along with Original Receipt of payment made by the patient to the hospital.
  • Break up of medicine / pharmacy / drugs / Operation Theatre (OT) drugs charges as mentioned in final bill.
  • Break up of investigation amount along with original reports for the same.
  • X-ray films mandatory in fracture/RTA & stone cases.
  • USG / C.T. Scan / M.R.I films mandatory along with reports

MAIN HOSPITALIZATION CLAIMS

  • In Road Traffic Accident (RTA) / Fracture cases a certificate from doctor required mentioning circumstances leading to injury / fracture. Was patient under the influence of alcohol / epilepsy / intoxication? – Treating Doctor to issue certification to this effect. Was Medico Legal Certificate (MLC) done? If Yes, certified copy of MLC has to be attached
  • All the bills must be submitted within 15 days from Date of Discharge from the hospital

SUBMISSION OF PRE-POST HOSPITALIZATION CLAIMS

  • Submit all the relevant bills related to investigation, consultation and any other medical treatment done relating with the ailment for which admission was taken in the hospital
  • The pre and post hospitalizations bills submitted must relate to period 30 days prior to the main hospitalization and 60 days subsequent to discharge after the MAIN HOSPITALIZATION

SUBMISSION OF DEFICIENCY RETRIEVALS

Please attach Xerox of Deficiency letter along with the documents required to clear your file

Note: Xerox Copy of the documents should be kept with the insured at all times for the documents submitted to PHS


You can print an e-card from internet; please follow the following procedure:

  • Go to , https://www.vipulmedcorp.com/
  • Then go to
  • Choose Vipul Medcorp as the insurance company
  • Policy Type – Group
  • Provide your name & employee no: (PMS ID)
  • You will be able to view particulars of yourself at the bottom of the page
  • On the right side (beside your particulars) there is a link for “Details”
  • Please click on details; it will show entire policy details along with all dependants insured (if any)
  • Against names of each member there is an option to view e-card; you can open the e-card from that link and can also print the same